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General NPI Number Information
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NPI Number | 1760440226
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Entity Type | Organization
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Legal Business Name | INTEGRATED COMMUNITY CLINICS PA
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 1101-2 N PROGRESS AVENUE
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City | SILOAM SPRINGS
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State | AR
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Zip | 72761-4343
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Country | US
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Telephone | 479-549-3079
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Fax | 479-549-3275
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Provider Business Mailing Address
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Address Line | 1101-2 N PROGRESS AVENUE PO BOX 1374
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City | SILOAM SPRINGS
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State | AR
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Zip | 72761-1374
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Country | US
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Telephone | 479-549-3079
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Fax | 479-549-3275
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | KELLY CHAMBERS
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Credential |
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Telephone | 479-549-3079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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